11 practical guidelines to start doing single session therapy

In the last article we talked about the 10 General Principles to be adopted to start integrating Single Session Therapy into your practice: today we see 11 practical guidelines.

As already mentioned, these are the Guidelines originally presented by the group of Rosenbaum, Hoyt & Talmon (1992) and since then a lot of water has passed under the bridge. Furthermore, in an article we do not think we can be exhaustive.

Nevertheless, they are very useful for the clinician who wants to start integrating TSS in his own practice, giving precise references. To these, then, you can add the reading of our free EBook Single Session Therapy. An introduction to principles and practices.

From general principles to the Guidelines

The General Principles and the research of the 3 authors led to the definition of some guidelines with respect to clinical intervention with Single Session Therapy. Since then there has been an evolution in literature and several Centers around the world have expanded and customized the practice. In our workshop in Single Session Therapy we explain the latest evolutions and adaptation to the Italian context.

In the meantime, however, it is interesting to see these first guidelines indicated

1. Sow change, through induction and preparation: we recently spoke about this concept at the X National Congress of the Italian Society of Hypnosis. Those familiar with the Ericksonian approach will have guessed what we are talking about, but in general the principle is easily applicable by any therapist. In general, it is necessary to disseminate, throughout the session (and also in the pre-session phase, when possible), the possibility that the change can also take place in that single meeting. 
2. Develop a therapeutic alliance: if this is a cornerstone of any psychotherapy, in TSS in particular, the alliance is also developing by co-creating precise and concretely achievable treatment goals with the client. 
3. Have enough time to complete each work session: avoid arriving at the end of the session with large gaps still to be treated. This, however, does not mean that it takes a long time. Many think that to do a TSS it takes longer sessions than the canonical ones: false. In the practice of the different Centers that we have studied we have seen TSS of 50, 60, 90 and even just 30 minutes. All effective. Much depends on the context and a lot on the therapist’s setting. On the other hand, if you have read the previous article, you will remember that a General Principle is that “more is not necessarily better”. 
4. Find ways to satisfy customers in their worldview and, at the same time, offer a new perspective or hope about being able to see and act differently. In these cases, we speak once again of “speaking the client’s language” rather than imposing our own vision of what is right or wrong, or what is normal or pathological. 
5. Go slow, let the client focus on his resources and strengths: this is certainly the key to every Single Session Therapy. 
6. Focus on pivotal chords: This is a concept developed by the work of Hoyt and colleagues. It is a question of identifying those moments, those issues, those points that prove to be key to achieving the goal set in the session. It will be appropriate to focus the session and the point of change on them. 
7. Prefer practical solutions: use the session to help the person seek solutions that inspire hope, readiness for change and future perspectives. Remember that if you see the patient once a week, the 167 hours he doesn’t spend with you are spent out there. This is not a contradiction to the Single Session: in fact, if you remember well the principle of TSS is “maximizing the effectiveness of each single session – which can be the only one”. 
8. Consider taking a break during the surgery, to point out and focus on some points: systemics know this technique well and many use it. However, it is not mandatory, but it could be useful for the clinician who is starting to use TSS, because it allows him to take 5-10 minutes to think locally and prepare practical indications to be given to the patient. 
9. Leave a few minutes for final considerations: it helps the person to have the sense that what has been done has been completed and satisfactory. Psychoanalysts and many other professionals speak of restitution; solution-focused therapists speak of “room for compliments”. Many approaches, in reality, give themselves a final space: in TSS this is used largely to maximize the person’s sense of competence. 
10. Give feedback, give back to the person the ability to understand and proceed with changes: remember that it is she who, once out of the study, will have to deal with her own problems. Remember not to refrain from giving her practical tasks, prescriptions or directions. 
11. Leave the door open: always offer the customer the opportunity to decide whether a single session was sufficient. 

Conclusions

Although we have declined the existence of different ways and the possibility for different approaches to practice TSS, as Italian Center for Single Session Therapy we have summarized, on the basis of numerous researches and our training in California and Australia, some guidelines adapted to the context Italian, to practice Single Session Therapy managing to maximize the effect of every single and often unique encounter.

In the next articles we will further explore principles and practices, talking about other studies and more recent evolutions.

 

Federico Piccirilli & Flavio Cannistrà

Psychologists, psychotherapists

Co-Founder and Founder of the Italian Center

for Single Session Therapy

 

Bibliography

Hoyt, M.F. & Talmon, M. (eds.) (2014a). Single Session Therapy and Walk-In Services. Bancyfelin, UK: Crown House (in traduzione).

Hoyt, M.F. & Talmon, M. (2014b). Editors’ Introduction: Single Session Therapy and Walk-In Services. In M.F. Hoyt & M. Talmon (eds.) (2014a), op. cit., pp. 2-26.

Slive, A. & Bobele, M. (2014). One Session at a time: When you have a Whole Hour. In M.F. Hoyt & M. Talmon (eds.) (2014), op. cit., pp. 95-119.

Rosenbaum, R., Hoyt, M.F. & Talmon, M. (1990). The Challenge of Single-Session Therapies: Creativing Pivotal Moments. In R.A. Wells & V.J. Giannetti (eds), Hanbook of the Brief Psychotherapies, New York-London: Plenum Press, pp. 165-189.

Talmon, M. (1990). Single Session Therapy. San Francisco: Jossey-Bass (Tr. it. Psicoterapia a seduta singola. Milano: Erickson).